**6. Diagnosis**

Dupuytren's disease is a clinical diagnoses based on a patient's history and physical exam. Its hallmark features consist of an indolent, progressive course characterized by palmar skin changes, painless nodules, and fibrotic cords leading to flexion contractures of the digits. Patients presenting with later findings of the disease consisting of fibrotic cords and contracted digits are more clearly diagnosed. Conversely, patients presenting with earlier features of Dupuytren's disease such as painless nodules may not be as easily distinguished from other diseases. Stenosing tenosynovitis, also known as a trigger finger, and soft tissue tumors may be mistaken for Dupuytren's disease. Stenosing tenosynovitis can be differentiated from Dupuytren's by tenderness over the A1 pulley with symptomatic locking or triggering of the digit and often no ROM deficit. Soft tissue masses typically do not present with skin thickening and pitting as seen in Dupuytren's disease. In addition, Dupuytren's nodules are often fixed to the skin and palmar fascia. Early Dupuytren's disease may be difficult to distinguish from diabetic cheiroarthropathy, however, involvement of multiple digits and a waxy appearance of the skin are clues to distinguish diabetic cheiroarthropathy. Other pathologies that may present with some features similar to Dupuytren's disease include: ulnar claw, rheumatoid arthritis, Volkmann's contracture, and camptodactyly. Radiographs should be considered in patients presenting with a history of trauma to rule out a fracture or dislocation. Further diagnostic imaging such as MRI may be considered in special cases to rule out suspicion of other disease processes, but is not required to diagnose Dupuytren's disease. A thorough history and physical exam is key to accurately diagnosing Dupuytren's disease.
